California Experiments With Fast-Tracking Medical School

First-year medical student Ngabo Nzigira gets ready to see a patient at Kaiser Permanente in Sacramento.

Andrew NixonCapital Public Radio

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Originally published on August 7, 2014 4:46 pm

Some doctors in the state of California will soon be able to practice after three years of medical school instead of the traditional four. The American Medical Association is providing seed money for the effort in the form of a $1 million, five-year grant to the University of California at Davis.

Student Ngabo Nzigira is in his sixth week of medical school and he's already interacting with patients during training with a doctor at Kaiser Permanente in Sacramento.

In a traditional med school, Nzigira wouldn't be in a clinic until his third year. In this accelerated course, students can shave up to $60,000 off the cost of their medical education. But Nzigira had hesitations.

"I thought, 'Oh man, you want me to put the intensity and stress that is medical school in four years, you want me to condense it down to three years. I'm not sure about that,' " Nzigira says. But after learning more, he became convinced it was a good path for him.

But medical schools aren't producing enough primary care doctors. Students may start med school saying they want to be internists or family practice doctors, but then end up choosing specialties that deliver higher salaries and shorter hours.

"Students come into medical school and they're passionate about patients, passionate about primary care, and then that wanes over time," Fancher says. "Part of it is the debt that they accrue, and part of it is the models of primary care that they're exposed to."

The new UC Davis curriculum is designed to make the choice to study family medicine a lasting one.

And California is not alone in this effort. Texas, Georgia and New York also have three-year medical schools. And both the AMA and the Association of American Medical Colleges support these initiatives as part of the redesign of medical education. The physician groups want students to advance based on their competency, not a set time frame.

That can be done without compromising quality of care, according to an article in JAMA, the journal of the American Medical Association.

Outside the Sacramento health center where Nzigira and other students are getting their first experiences in clinical practice, people were not troubled by the idea of a faster track through medical school. Angela Woodard says even doctors with four years of training may have trouble treating patients.

"There's already consequences on quality of care. So them going to school for a shorter time is not going to make it any worse," Woodard said.

Patient Joe King isn't too concerned either, "as long as they maintain the same criteria of standards that primary care doctors have to meet."

UC Davis' medical students are guaranteed a residency, a final training step that takes three years after medical school for primary care doctors, including pediatricians.

This story is part of a reporting partnership between NPR, Capital Public Radio and Kaiser Health News.

We will continue following that story and also follow health care in the United States. Medical school in this country is traditionally a four-year commitment. Now some primary care doctors in California will be able to practice after three years. The American Medical Association has funded a new, three-year medical school initiative. Capital Public Radio's Pauline Bartolone reports on why authorities want primary care physicians on the job faster.

PAULINE BARTOLONE, BYLINE: It's Ngabo Nzigira’s sixth week of medical school at University of California in Davis, and he's already interacting with patients.

(SOUNDBITE OF ARCHIVED RECORDING)

NGABO NZIGIRA: So we have the Norco. Are you still taking this?

UNIDENTIFIED PATIENT: Yes.

NZIGIRA: OK, great.

BARTOLONE: Nzigira is being trained by a doctor at Kaiser Permanente in Sacramento.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED DOCTOR: So if I pushed here, over in the shin, and it didn't leave a mark but you still feel it's kind of squishy, that's non-pitting edema, right?

NZIGIRA: OK.

BARTOLONE: Normally, he wouldn't be in a clinic until his third year. In this accelerated program, students can shave up to $60,000 off their medical school debt. But Nzigira had hesitations.

NZIGIRA: I thought, oh, man, you want me to put the intensity and stress that is medical school in four years, and you want me to condense it down to three years. I'm not sure about that.

BARTOLONE: The curriculum cuts out summer vacations, electives and the residency search. It's designed to get primary care physicians into the field faster.

BARTOLONE: Dr. Tonya Fancher is heading up the new curriculum. UC Davis says the Affordable Care Act compounds the need for more primary care providers. And Fancher says their model is designed to make the choice to study family medicine a lasting one.

FANCHER: Students come into medical school. They're passionate about patients, passionate about primary care. And then, that wanes over time. Part of it is probably the debt that they accrue in school, right? And part of it are the models of primary care that they're traditionally exposed to.

BARTOLONE: Other states have three-year medical schools - Texas, Georgia and New York. The AMA and the Association of American Medical Colleges support the design. They say they want students to advance based on competency, not a set time frame. People outside this Sacramento health center aren't troubled by the change. Angela Woodard says even doctors with four years of medical school have trouble treating patients.

ANGELA WOODARD: There's already consequences on quality of care. So them going to school a shorter time is not going to make it any worse.

BARTOLONE: Patient Joe King isn't too concerned either.

JOE KING: As long as they maintain the same criteria of standards that primary care doctors have to meet in order to be one, I don't see a problem.

BARTOLONE: The UC Davis students are guaranteed a residency, another training step before facing patient expectations on their own. For NPR News, I'm Pauline Bartolone in Sacramento.

INSKEEP: Hey, that story was part of a reporting partnership with NPR News, Capital Public Radio and Kaiser Health News. Transcript provided by NPR, Copyright NPR.